Establishment and Validation of a Nomogram Model for Prediction of Diabetic Nephropathy in Type 2 Diabetic Patients with Proteinuria

Abstract

Purpose

To establish and validate the nomogram model for predicting diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients with proteinuria.

Methods

A total of 102 patients with T2DM and proteinuria who underwent renal biopsy were included in this study. According to pathological classification of the kidney, the patients were divided into two groups, namely, a DN group (52 cases) and a non-diabetic renal disease (NDRD) group (50 cases). The clinical data were collected, and the factors associated with diabetic nephropathy (DN) were analyzed with multivariate logistic regression. A nomogram model for predicting DN risk was constructed by using R4.1 software. Receiver operator characteristic (ROC) curves were generated, and the K-fold cross-validation method was used for validation. A consistency test was performed by generating the correction curve.

Results

Systolic blood pressure (SBP), diabetic retinopathy (DR), hemoglobin (Hb), fasting plasma glucose (FPG) and triglyceride/cystatin C (TG/Cys-C) ratio were independent factors for DN in T2DM patients with proteinuria (P<0.05). The nomogram model had good prediction efficiency. If the total score of the nomogram exceeds 200, the probability of DN is as high as 95%. The area under the ROC curve was 0.9412 (95% confidence interval (CI) = 0.8981–0.9842). The 10-fold cross-validation showed that the prediction accuracy of the model was 0.8427. The Hosmer-Lemeshow (H-L) test showed that there was no significant difference between the predicted value and the actual observed value (X² = 6.725, P = 0.567). The calibration curve showed that the fitting degree of the DN nomogram prediction model was good.

Conclusion

The nomogram model constructed in the present study improves the diagnostic efficiency of DN in T2DM patients with proteinuria, and it has a high clinical value.

Keywords:

• diabetic nephropathy
• non-diabetic renal disease
• nomogram model
• type 2 diabetes mellitus

Ethics Statement

This study was approved by the Institutional Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Ethics No. XYFY2021-KL073-01).

Author Contributions

All authors made a significant contribution to the work reported as follows: conception, design and execution of the study; acquisition, analysis and interpretation of data; participated in drafting, revising or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work. These authors contributed equally to the manuscript: Dong-mei Zhou and Jing Wei.

Disclosure

The authors declare that they have no conflicts of interest for this work.